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NPI Code Detail

MEDICARE: MOIRA MACLEAN-WIDEMAN

MEDICARE: MOIRA MACLEAN-WIDEMAN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor
2101YM0800XMental Health Counselor
3101YM0800XMental Health CounselorLMHC10002094MA

General Provider Information

NPI Number : 1942677471
Entity Type Code : Individual
Provider Name (Legal Business Name) : MOIRA MACLEAN-WIDEMAN
Provider Business Mailing Address
First Line : 40 SHATTUCK RD STE 250
Second Line :
City : ANDOVER
State : MA
Zip : 01810-2492
Country : US
Telephone Number : 978-222-3121
Fax Number :
Provider Business Practice Location Address
First Line : 40 SHATTUCK RD STE 250
Second Line :
City : ANDOVER
State : MA
Zip : 01810-2492
Country : US
Telephone Number : 978-222-3121
Fax Number : 617-376-8910
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/01/2015
Last Update Date : 04/23/2024

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Directions to “ MOIRA MACLEAN-WIDEMAN ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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